Correlation Study Between BRAF V600E Gene Mutation And Clinicopathological Features Of Hashimoto’s Thyroiditis With Papillary Thyroid Carcinoma

Objective To investigate the clinical and pathological features of Hashimoto’s thyroiditis(HT)complicated with thyroid papillary carcinoma(PTC),and to analyze the effect of HT and BRAF gene mutations on the degree of PTC malignancy.Method Patients who underwent thyroidectomy at the Affiliated Hospital of Qingdao University from June 2017 to August 2018 and whose pathology was confirmed to be PTC(including HT and non-HT)were selected.(1)Collect basic clinical and pathological data of patients,such as age,gender,primary tumor diameter,number,location,extracapsular invasion,lymph node metastasis,number and size of lymph node metastasis,distant metastasis,HT and BRAF gene mutations;thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb)levels,TSH,FT4,FT3 levels,and assessment of patient recurrence risk stratification and TNM staging;(2)Analyse the effects of HT and BRAF gene mutations on the clinicopathological features of PTC patients;(3)Analyse differences in thyroid antibody and thyroid hormone levels under different clinicopathological features;(3)Analyse differences in thyroid antibody and thyroid hormone levels in different clinical and pathological features;(4)Analyse the effect of BRAF gene mutation on clinical and pathological features of patients with PTC and Hashimoto’s thyroiditis,and analyze the effects of HT on clinical and pathological features in PTC patients with BRAF mutations;(5)Multivariate analyse the risk of lymph node metastasis and extracapsular invasion in patients with PTC.Results(1)There were 882 patients with PTC,including 239(27.10%)with HT,722(81.86%)with BRAF mutation,182(76.15%)with BRAF mutation in PTC with HT;PTC with non-combined HT 540 cases of BRAF gene mutation(83.98%).(2)Compared with non-HT group,PTC patients with HT had higher proportion of female,multiple lesions,no BRAF gene mutation and lymph node metastasis,and the differences were statistically significant(P<0.05).There was no significant difference in stratification of recurrence risk and TNM staging(P>0.05).There was no significant difference in HT and non-HT between the number,diameter and risk of lymph node metastasis(all P>0.05).(3)The levels of TPOAb,TGAb and TSH in the lymph node metastasis group of PTCpatients were higher than those without lymph node metastasis(P<0.05).There was no statistical difference between FT4 and FT3 in lymph node metastasis group and non-metastasis group.(both P>0.05).(4)Among patients with PTC,BRAF mutations were more frequent in multiple lesions,extracapsular invasion,high risk of recurrence,and TNM stage III/IV.The differences were statistically significant(both P<0.05),there was no significant difference in lymph node metastasis(P>0.05).There was no significant difference between BRAF gene mutation and non-mutation in the group of lymph node metastasis,diameter and risk(P>0.05).(5)In PTC patients,compared with the non-mutation group,the BRAF gene mutations had lower levels of TPOAb,TGAb and TSH,and the differences were statistically significant(P<0.05).(6)In patients with PTC,compared with non-mutated patients,BRAF mutations have a large proportion of multiple lesions,extracapsular invasion,lymph node metastasis,recurrence risk stratified medium/high risk and TNM III / IV,the difference was statistically significant(P<0.05);Among the PTC patients with BRAF mutation,the proportion of women with HT,multiple lesions and lymph node metastasis was greater than non-HT patients.The differences were statistically significant(P<0.05).(7)Regardless of whether PTC patients have HT or BRAF mutations,lymph node metastasis,extracapsular invasion,stratified mid/high risk recurrence risk,and TNM staging III/IV ratio are significantly higher in patients with non-small cancer than in patients with small cancer(P < 0.05).(8)Multiple lesions,tumor diameter >1cm,combined with HT were independent risk factors for lymph node metastasis in PTC patients(OR value = 2.343,2.915,1.683,all P < 0.05);primary tumor diameter >1cm,BRAF gene mutation were independent risk factors for extracapsular invasion in PTC patients(OR value = 2.931,1.619,both P < 0.05).Conclusions(1)PTC with concurrent HT is more common in women,more prone to multiple lesions and lymph node metastasis,but does not affect the prognosis.(2)High levels of TPOAb,TGAb and TSH promote lymph node metastasis in PTC patients.(3)PTC patients with BRAF mutations are more likely to have multiple lesions and extracapsular invasion,with a higher risk of recurrence and TNM staging.(4)Patients with PTC combined with HT and BRAF mutations have a high rate of lymph node metastasis,strong invasiveness,and aggravate poor prognosis.(5)Multiple lesions and lesions >1cm in diameter,combined with HT were independent risk factors for PTC lymph node metastasis;primary tumor diameter >1cm,BRAF gene mutation was an independent risk factor for PTC extracapsular invasion.